content analysis in nursing research

Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness

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• 1 Department of Nursing, Umeå University, Umeå 90187, Sweden. [email protected]
• PMID: 14769454
• DOI: 10.1016/j.nedt.2003.10.001

Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.

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• Concept Formation
• Interviews as Topic / methods
• Nursing Research / methods*
• Nursing Research / standards
• Observation / methods
• Qualitative Research*
• Reproducibility of Results

Content Analysis in Systematic Reviews

• First Online: 01 November 2019

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• Kristina Mikkonen 4 &
• Maria Kääriäinen 4 , 5 , 6  

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This chapter aims to present a methodological example of how content analysis can be applied to systematic reviews of nursing science research. The chapter will explain why systematic reviews are conducted in the field of nursing science, present the methodological rigidness of the systematic review, and later detail how content analysis can be used to examine chosen original studies. This chapter also includes a practical example that will guide the reader through the analytical process.

The quality of the presented review—in which content analysis is employed for data synthesis—is also critically discussed.

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Centre for Reviews and Dissemination (CRD). Systematic reviews: CRD’s guidance for undertaking reviews in health care. York: University of York: CRD; 2009.

Google Scholar  

Aromataris E, Pearson A. The systematic review: an overview. Am J Nurs. 2014;114:53–8.

PubMed   Google Scholar  

Pearson A, Wiechula R, Lockwood C. The JBI model of evidence-based healthcare. Int J Evid Based Healthc. 2005;3:207–15.

Joanna Briggs Institute (JBI). Joanna Briggs Institute Reviewers’ Manual. 2014 ed. University of Adelaide: The Joanna Briggs Institute; 2014.

The Cochrane Handbook for Systematic Reviews of Interventions. 2018 ed. Cochrane Training; 2018.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

Article   Google Scholar  

Weaver K, Olson JK. Understanding paradigms used for nursing research. J Adv Nurs. 2009;53(4):459–69. https://doi.org/10.1111/j.1365-2648.2006.03740.x .

Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12:181.

Stern C, Jordan Z, McArthur A. Developing the review question and inclusion criteria. Am J Nurs. 2014;114:53–6.

Konttila J, Siira H, Kyngäs H, Lahtinen M, Elo S, Kääriäinen M, Kaakinen P, Oikarinen A, Yamakawa M, Fukui S, Utsumi M, Higami Y, Higuchi A, Mikkonen K. Healthcare professionals’ competence in digitalization: a systematic review. Journal of Clinical Nursing. 2018;1–17.

Aromataris E, Riitano D. Constructing a search strategy and searching for evidence. Am J Nurs. 2014;114:49–56.

Mikkonen K, Elo S, Tuomikoski AM, Kääriäinen M. Mentor experiences of international healthcare students’ learning in a clinical environment: a systematic review. Nurse Educ Today. 2016;40:87. https://doi.org/10.1016/j.nedt.2016.02.013 .

Article   PubMed   Google Scholar  

Mikkonen K, Elo S, Kuivila HM, Tuomikoski AM, Kääriäinen M. Culturally and linguistically diverse healthcare students’ experiences of learning in a clinical environment: a systematic review of qualitative studies. Int J Nurs Stud. 2016;54:173–87. https://doi.org/10.1016/j.ijnurstu.2015.06.004 .

Averis A, Pearson A. Filling the gaps: identifying nursing research priorities through the analysis of completed systematic reviews. JBI Reports. 2003;1:49–126.

Porritt K, Gomersall J, Lockwood C, et al. Am J Nurs. 2014;114:47–52.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26: 91–108.

Critical Appraisal Tools. Joanna Briggs Institute (JBI). 2017. https://joannabriggs.org/critical_appraisal_tools .

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:1–10.

Munn Z, Tufanaru C, Aromataris E. Data extraction and synthesis. Am J Nurs. 2014;114:49–54.

Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62:107–15.

Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:1–7.

Robertson-Malt S. Presenting and interpreting findings. Am J Nurs. 2014;114:49–54.

EQUATOR Network, Enhancing the Quality and Transparency Of health Research. 2019. http://www.equator-network.org/ .

Ellot D, Campbell T. “Really on the ball”: exploring the implications of teachers’ PE-CPD experience. Sport Educ Soc. 2017;20(3):381–97. https://doi.org/10.1080/13573322.2013.765400 .

Paul P. Transition from novice adjunct to experienced associate degree nurse educator: a comparative qualitative approach. Teach Learn Nurs. 2015;10:3–11.

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Mikkonen, K., Kääriäinen, M. (2020). Content Analysis in Systematic Reviews. In: Kyngäs, H., Mikkonen, K., Kääriäinen, M. (eds) The Application of Content Analysis in Nursing Science Research. Springer, Cham. https://doi.org/10.1007/978-3-030-30199-6_10

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• Published: 29 April 2024

Exploring the consequences of nurses’ involvement in disaster response: findings from a qualitative content analysis study

• Jamileh Farokhzadian   ORCID: orcid.org/0000-0002-9621-3486 1 ,
• Parvin Mangolian Shahrbabaki   ORCID: orcid.org/0000-0003-0539-5390 1 ,
• Hojjat Farahmandnia   ORCID: orcid.org/0000-0002-3264-6792 2 ,
• Gülcan Taskiran Eskici   ORCID: orcid.org/0000-0001-8331-4897 3 &
• Faezeh Soltani Goki   ORCID: orcid.org/0000-0001-7908-8153 2  

BMC Emergency Medicine volume  24 , Article number:  74 ( 2024 ) Cite this article

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The presence of nurses during disasters can lead to many consequences. Understanding the nurses’ experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters.

This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data.

After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems.

Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.

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Introduction

The presence of nurses during disasters has significant impacts that highlight their crucial role in such situations. Their presence ensures immediate medical care for those affected, reducing casualties and potentially saving lives [ 1 ]. Nurses assess and prioritize patients, efficiently allocating resources to provide prompt care to those in critical needs. Additionally, they offer emotional support to survivors, providing reassurance and alleviating anxiety in chaotic circumstances [ 2 ]. With their expertise in psychological first aid and counseling, nurses help victims cope with the psychological aftermath of the disaster [ 3 ]. Nurses also play a vital role in coordinating efforts with other healthcare professionals, emergency response teams, and community organizations, facilitating a holistic approach to disaster management [ 4 ]. In a systematic review by Timalsina’s, highlights the presence of nurses during disasters that contributes to reducing the adverse effects of such events. Their provision of immediate medical care, emotional support, coordination efforts, and contribution to disaster preparedness all demonstrate their crucial role in ensuring a comprehensive and effective response to emergencies [ 5 ].

Disasters can have a profound impact on healthcare systems and the nurses who work within them [ 6 ]. Nurses may encounter a range of challenges at the personal, professional, organizational and family levels during disasters. These challenges can have adverse consequences for their well-being [ 7 ]. A Croatian study by Civljak et al., it was found that 70% of nurses reported experiencing physical and psychological injuries during disasters [ 8 ]. According to Vagni et al. study from Italy the physical and mental vulnerability of nurses in the work environment is further intensified during disasters, leading to irritability, difficulty sleeping, intrusive thoughts, reduced activity level, emotional numbness, and emotional exhaustion [ 9 ]. Therefore, nurses are more exposed to adverse consequences during disasters than other healthcare professionals. Wang et al. highlighted factors that can help reduce the impact of disasters on nurses [ 10 ]. These factors can include creating positive relationships with nurses based on respect, understanding and reassuring them [ 11 ]. Furthermore, Said et al., in a review study, reported that by increasing the competencies of nurses in disaster response, they could gain positive and desirable achievements when present during disasters [ 3 ].

A study by Alharbi in Saudi Arabia reported that identifying the consequences that nurses face during disasters can help to properly prepare and effectively train nurses and generally improve health and minimize injuries during disaster [ 12 ]. A meta-synthesis study was conducted by Ma on the experiences of nurses involved in disasters. Researchers stated that health managers need to discover and understand the consequences of disasters for nurses more deeply in order to meet the needs of nurses, support programs and improve the quality of care during disasters [ 13 ].

Although several reports have highlighted the negative consequences of the nurse’s presence, they is still a lack of comprehensive understanding of these issues [ 14 , 15 ]. A review of the conducted studies showed that these studies focused on various aspects of the roles, challenges and preparation of nurses in responding to disasters or only examined the knowledge, attitudes and competencies of nurses and the factors affecting them [ 16 , 17 , 18 ]. Since qualitative studies are context-based and different results are obtained in different fields, qualitative studies that explore the experiences of nurses during disasters can provide valuable insights and rich details. By gaining an in-depth understanding of these experiences, it is possible to minimize the negative effects and maximize the benefits that are important for both nurses and organizations. Investigating and comprehensively understanding the outcomes can help identify strategies to minimize the adverse consequences and enhance positive outcomes that arise from nurses’ involvement in disasters.

Study design

We applied conventional qualitative content analysis to explain the experiences of nurses regarding about the consequences of their presence during disasters. Qualitative content analysis design allows for multifaceted descriptions that attempt to understand and convey people’s experiences. Especially in situations where there is limited knowledge [ 19 ]. This design provides a valuable way to address critical clinical issues with a primary emphasis on participation [ 20 ].

Participants and setting

Using purposive sampling method, this study was conducted on 20 nurses (12 women, 8 men) in the emergency departments of hospitals affiliated to Kerman University of Medical Sciences in southeastern Iran, from March 2023 to November 2023. After obtaining permission, the researchers went to the nursing offices of hospitals involved in disasters. The considered nurses were selected with the introduction and guidance of nursing managers. The participants were nurses who have been involved in disaster response efforts. Nurses who, in addition to Corona, provided care during other natural and man-made disasters, were the sample of this study. We selected nurses who were willing to express their experiences and had good expressive power to increase our understanding of the phenomenon under study. The interviews were conducted in quiet places such as the supervisor’s or educational supervisor’s room with the coordination and agreement of the participants. Also, the interviews continued until data saturation was reached. It means that no more data and new concepts of the desired phenomenon were obtained. In our study, 18 interviews were conducted until the saturation point was reached. But to ensure that no new concepts were developed, two additional interviews were conducted. Therefore, there were 20 interviews in total.

Data collection

Data was collected by face-to-face, semi-structured interviews. All interviews were conducted by the first author, who has a 20-year clinical experience and is proficient in qualitative research. During the interviews, a set of general questions were asked, such as “What were your general experiences of being in the disaster?”, “What was the impact of your presence during disasters on your mental and physical health?”(Table  1 ). Follow-up questions such as” Can you explain more?” or” Can you give an example?” were used. The interviewer tried to suspend her own idea about the study topic. The interviews lasted between 30 and 60 min, and MAXQDA10 was utilized for coding, categorizing, and extracting theme. Sampling was performed with maximum variation in terms of age, gender, and the number of years of work, Duration of being during disasters, type of disasters experienced by participants, experience and job position.

Data analysis

The qualitative content analysis approach suggested by Graneheim and Lundman was used for this study [ 21 ]. The data analysis was carried out concurrently and continuously with the data collection process. After each interview, the entire text of the interview was transcribed. In the next step, the whole text was read several times to get a general understanding of the content. The meaning units were then selected and the original codes decoded. The codes were then categorized based on their similarities and differences. Finally, the hidden content of the information was extracted.

Trustworthiness

In order to ensure the trustworthiness of the study, we applied four key criteria throughout the research process: credibility, dependability, conformability, and transferability [ 22 ]. To enhance credibility, researchers conducted member checks with participants during data collection and analysis. This involved participants reviewing interview content, codes, and themes to ensure accuracy and reflection of their experiences. Peer checking techniques were also utilized to further support credibility through long-term engagement with the data. For dependability, all raw data, codes, and subcategories were saved for auditing purposes, with detailed notes on study procedures. To ensure conformability, researchers shared reflective manuscripts on the research topic, allowing for acknowledgment of previous experiences and understandings. Reflective thinking was also employed to set aside personal biases and perspectives. Lastly, a diverse sampling approach was used to improve the transferability of findings.

Ethical considerations

This study has been approved by the ethics committee of Kerman University of Medical Sciences, with the code (IR.KMU.REC.1401.188). Describing the purpose of the research, obtaining written informed consent forms to participate in the study and recording their voice from all the participants, commitment to share the findings if desired, maintaining the anonymity, and the participants’ being able to withdraw at any stage of the research were the ethical considerations of this study. The study adhered to the ethical principles outlined in the Declaration of Helsinki ( http://www.wma.net/en/30publications/10policies/b3/ ).

Of the 20 nurses who participated in the study, 11 were male nurses, 18 were married, and 14 had a bachelor’s degree. The mean age of the participants was 43.4 ± 6.5 years, and they had an average work experience of 17.1 ± 5.99 years. In terms of professional status, the participants consisted of 16 staff nurses, 1 nurse manager, 3 supervisors, and 4 matrons (Table  2 ). The reason for selecting samples from different categories of nurses was to gain a broader perspective on the topic being investigated. Nurses at different management levels and in different specialties have different experiences and insights that can contribute to a more comprehensive understanding of the subject.

The analysis of the interviews identified two main categories: acquiring experience in difficult conditions and overlapping of job frustrations. The main category of acquiring experience in difficult conditions encompassed several subcategories, including improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the main category of overlapping of job frustrations comprised the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems (Table  3 ). The following quotes from the participants further explain these categories and subcategories.

Acquiring experience in difficult conditions

Despite the adverse consequences, nurses have consistently demonstrated their unwavering reliability as responders during disasters, often putting their own safety at risk to aid patients. They firmly believe that their presence during disasters allows them to gradually acquire competencies that yield positive and constructive outcomes. This category encompasses a range of subcategories, including improved quality of care, invaluable experience and dedication in fulfilling role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status.

Improved quality of care

According to the participants, when nurses are competent and adequately prepared for a disaster, they are able to react and respond swiftly. As a result, patients benefit from improved access to care, while effective time management is also facilitated.

Upon returning from the devastating earthquake in Zarand, a city in southeastern Iran, I immediately went to the emergency room at Hospital S-B. However, this time, I was able to triage the patients much more efficiently than I had done in the past. (Participant # 6) The respiratory team consisted of highly competent and skilled nurses, collaborating closely with expert doctors. In addition to providing care and treatment, they also took on the responsibility of educating other nurses. As a result, the quality of care provided by the nurses improved significantly, and we were confident that patients would be promptly connected to ventilators without any unnecessary delays. (Participant # 15)

Experience and dedication in fulfilling the role

The presence of nurses in disasters provided them with valuable opportunities to test and address any skill deficiencies they may have had. As a result, they played a crucial and effective role in delivering care at various levels. Consequently, they gained a reputation as highly competent nurses with a broader skill set compared to their counterparts.

When comparing nurses who have experienced earthquakes, floods, and other disasters with those who have not, the former tend to possess a higher level of resilience and adaptability. Regardless of the setting they are placed in, these nurses bring a sense of confidence and ease. (Participant # 20) Being present during disasters, such as the COVID-19 pandemic, made us acutely aware of our knowledge gaps and motivated us to seek improvement. We specifically want to learn how to work with a ventilator and perform intubation, skills we had not possessed previously. This realization stem from the need to effectively care for COVID-19 patients. We are confident that this newfound knowledge would undoubtedly prove valuable for our future practice. (Participant # 5)

Reduced stress

Nurses recognized the critical significance of stress reduction after attaining competence. Drawing from their extensive experience in disaster care, they witnessed firsthand the profound impact that stress can have on patient outcomes and the overall quality of care. Consequently, they understood that by reducing stress, they could enhance their cognitive abilities, minimize errors, and make more robust decisions.

Confidence in our skills and knowledge plays a crucial role in reducing a significant amount of stress. Continuous learning and development further contribute to our ability to adapt to new challenges, which, in turn, helps reduce stress. (Participant #8) Following the completion of disaster management training and specific training for the Corona response team, nurses who initially felt stressed about being deployed to affected areas willingly volunteered to provide care during disasters. (Participant #3)

Occupational motivation and enthusiasm

The experience of being present during disasters and the pursuit of necessary competencies sparked a deep interest and motivation among nurses in their work. This motivation enabled them to endure even the most challenging working conditions and effectively deal with their responsibilities.

By saving patients’ lives and experiencing the profound sense of usefulness that comes with it, my motivation has significantly increased. This newfound motivation has instilled in me a strong readiness to go to any part of the country to provide assistance to patients in need. (Participant #5) The nurse’s role in aiding earthquake victims was often likened to that of an angel. This recognition of the nurse’s profound impact and the belief that I had done a great job served as a powerful motivator to continue my work. (Participant #17)

Increased self-confidence

According to the participants, their work experience in disaster had a profound impact on the improvement of their skills. This improvement, in turn, led to increased self-confidence, enabling them to provide independent care, initiate patient diagnoses, intervene effectively, and make informed decisions about patient care. The nurses expressed that the more they worked in disasters, the more their confidence grew.

Repetition of a task tends to increase confidence and competence. This is particularly true for specialized tasks like disaster triage, which differs significantly from routine practice. Having previously performed disaster triage multiple times, I was confident and certain in my ability to make quick and accurate decisions about the priority of patients. (Participant #19)

Nurses often encounter various challenges and difficulties on the path of obtaining competencies. However, through repetition and dedicated practice, nurses can strengthen their self-confidence and enhance their knowledge and learning. This continuous repetition allows nurses to refine their skills and perform their caregiving functions effectively.

In situations where casualties with cardiopulmonary arrest arrived at the Emergency Department, it was common for nurses to find themselves alone and responsible for initiating life-saving measures. With confidence in my knowledge and abilities, I took immediate action by calling the code and swiftly initiating CPR. However, many nurses tend to wait for the doctor’s arrival due to a lack of confidence in their own abilities. (Participant # 13)

Improved social status

The participants expressed that despite enduring numerous hardships during disasters, they never regretted being present to provide care. The efforts and dedication of the nurses were highly praised by the patients they served. They considered the attention and support of the media, society and managers as a sign of improving their social status and this led to higher job satisfaction for the nurses.

The media coverage highlighting the discharge of COVID-19 patients and the crucial role played by nurses in saving lives has resulted in people considering nurses as heroes. The dedication and sacrifice of tens of thousands of nurses who risked their lives on the front lines to provide care have earned them immense respect and admiration in society. Being recognized as a hero by both the public and within one’s own profession is a great honor for me. (Participant # 14)

Therefore, nurses have significantly improved society’s perception of the nursing profession through their selfless sacrifices, willingness to risk their lives, and utilization of their skills and knowledge during disasters.

Managers played a crucial role by providing nurses with the necessary equipment and comfortable accommodations, which greatly supported their work. People in the community showed immense respect and followed our advice, recognizing our expertise and dedication. The outpouring of praise for the healthcare team on social media further reinforced the positive impact of their efforts. This recognition improved the social image of nurses. (Participant #17)

Nurses often face occupational consequences that are inherent to their profession. However, during disasters, the impact on their bodies and minds becomes even more pronounced. This can be seen across several subcategories, including deterioration of physical strength, psycho-emotional distress, increased exposure to violence and aggression, occurrence of family problems, discontinued from supports, and feeling of hopelessness.

Deterioration of physical strength

When analyzing physical strength, it becomes evident that many nurses sacrificed their own health during disasters. The demanding circumstances, including extended work hours without breaks, prolonged standing, inadequate sleep and nutrition, heavy lifting, and the overall physical demands of their role during such crises, often exceeded their physical endurance. Consequently, their health becomes compromised due to the strain placed on their bodies.

During a long shift, I often find myself juggling multiple tasks simultaneously. I not only have to meet the needs of patients but also interact with families who are seeking updates and reassurance. Moreover, I may face requests from multiple doctors for various procedures, further adding to my workload. one nurse alone is insufficient to handle all the work. As the shift progresses, I may experience physical discomfort such as backpain and foot ache. (Participant # 1) After enduring 12–16-hour workdays, I experienced profound fatigue, to the point where I could almost fall asleep while standing. The physical strain of such long hours resulted in pervasive pain throughout my body. (Participant # 9)

During disasters, nurses might encounter hazardous substances, including chemicals and radiation, as well as face challenges such as dehydration, heat stroke, and extreme cold. These exposures can give rise to respiratory issues, skin irritation, and other health problems.

Psycho-emotional distress

The participants in the study reported experiencing both short-term and long-term consequences of mental-psychological injuries. Some participants expressed feelings of helplessness, isolation, and rumination as immediate reactions. In the initial days following the disaster, many experienced a sense of shock. However, even years later, the aftermath left lasting effects, including traces of depression and mental-psychological disorders among individuals.

Currently, many of us are experiencing challenges with our mental health. It seems that we all have been affected by various mental stressors, and our tolerance levels have significantly decreased. This has led to difficulties in tolerating others, including our own family members. It is important to note that this situation is not unique to me; my colleagues are also facing similar struggles. (Participant # 14)

Furthermore, the participants experienced emotions such as sadness, depression, hopelessness, anxiety and shock.

As I entered the hospital, an overwhelming sense of sadness enveloped my heart. I felt an intense urge to cry. Memories of patients who had been alive just the day before, but were no longer with us, flooded my mind. The uncertainty surrounding the patients’ conditions added to my distress. The thought of something happening to them weighed heavily on my mind. Each shift was filled with constant worry and anxiety, not only for the patients but also for myself. (Participant #4)

Increased exposure to violence and aggression

During times of disasters, when individuals are gripped by fear, shock, and uncertainty, there is a disturbing trend of increased violence against nurses. The participants in the study perceived this aggression and violence as a significant threat to their safety and overall well-being. Such acts of violence have led to a range of negative psychological consequences for nurses, including feelings of humiliation, guilt, anxiety, depression, fear, hopelessness, burnout, and helplessness.

Despite our best efforts , there was a perception among others that we did not perform well. This led to hurtful comments, which only added to our exhaustion. (Participant # 1) In those challenging conditions, we endured numerous hardships, including inadequate food, sleep deprivation, long shifts, and low salaries. However, what remains etched in my mind is the way companions, who were grieving the loss of their loved ones, expressed their frustration through obscenities and acts of violence towards us. These behaviors had a lasting impact on me. (Participant # 13)

Occurrence of family problems

One of the adverse effects of nurses’ presence during disasters was the strain it placed on their family relationships. Being away from their families and unable to fulfill their family responsibilities caused discomfort and led to protest from family members.

During a critical period when my family needed me the most, I made the difficult decision to be away from them. Reflecting on this, I question whether I have been able to fulfill my role as a good father to them. (Participant # 11)

In contrast, the frequent absence of nurses from the family environment was perceived as a form of evading life responsibilities, placing an increased burden on their spouses and other family members. This dynamic had negative effects on family relationships, leading to the emergence of conflicts among them.

My daughter, who suffers from epilepsy, experienced a severe epileptic attack while I was away during the Zarand earthquake. My wife holds me responsible for this incident, as my daughter heavily relies on me and I had been absent for an extended period. The weight of the situation was unbearable for her. (Participant # 3)

Discontinued from supports

Participants recognized that the COVID-19 pandemic brought about distinct challenges for nurses beyond the hospital setting. They highlighted various social effects, such as the experience of stigma, tense interactions with others, and feelings of isolation and loneliness.

After leaving the hospital, I noticed that my cousin started to distance herself from me. It was difficult to experience this rejection, as I felt others were avoiding me due to my role as a nurse constantly caring for COVID-19 patients. (Participant # 17) I had a sense of being caught in the midst of plague, feeling as if I had contracted the disease myself. When I hailed a taxi to go to the hospital, I had to provide an address close to the hospital just to convince the driver to take me. This experience was truly distressing and painful. (Participant # 12)

Feeling of hopelessness

Nurses felt weak and unable to provide care due to reasons such as excessive demands, lack of resources, and the need to provide care in challenging conditions. This feeling of helplessness made them feel hopeless.

As family members cried and embraced their loved ones, I stood there, filled with a mix of astonishment and sorrow. In that moment, I questioned the purpose of my own existence, knowing that my role was solely to extract lifeless bodies from beneath the rubble. (Participant # 16) It was undeniably disheartening, as we encountered numerous cases of patients for whom we were unable to provide any assistance. The lack of sufficient equipment and medicine only exacerbated the frustration we felt in our efforts to help them. (Participant # 3)

The data analysis revealed two main categories: overlapping of job frustrations and acquiring experience in difficult conditions. The research findings indicated that nurses experienced both positive and negative consequences by being present during disasters and striving to acquire the necessary competencies to respond effectively. The positive consequences propelled them towards professional growth and kept them motivated, while the negative consequences hindered their ability to fulfill their roles effectively.

One of the positive consequences was the improvement of the quality of care. Said et al. emphasized the crucial role of competent nurses in ensuring patient safety, reducing errors, and enhancing the overall quality of care [ 23 ]. Another study demonstrated that competent nurses, through their timeliness and quick response, instilled a sense of satisfaction and hope among the injured [ 24 ]. Additionally, in a study titled “key aspects of access to healthcare during disasters,” researchers identified competent nurses as a vital strategy for enabling faster access to healthcare, effective organization and planning, and the active participation of all segments of society in disaster response [ 25 ].

The participants in the study expressed that their professional self-confidence significantly increased as a result of their involvement in disasters. This finding aligns with the results of a study titled “protecting the psychological well-being of staff exposed to disasters: a qualitative study.” In this study, one of the categories was the positive consequences of nurses’ experiences during disasters. These included enhanced morale and self-confidence, a greater appreciation for life, increased emotional maturity, increased compassion, empathy, and understanding of individuals facing challenging circumstances [ 26 ]. Studies have shown that high levels of professional self-confidence among nurses enhance safe nursing practices, positively influence patient care, and contribute to successful career outcomes [ 27 , 28 ]. Nurses with higher self-confidence exhibit more positive behaviors towards patients and family members, are more proactive in emergency situations, and show increased competence in decision-making and clinical skills. Additionally, self-confidence is associated with better interaction with patients, improved self-esteem, resilience, and reduced levels of anxiety and stress, especially during challenging times like disaster [ 28 ].

In addition, Eubank et al. highlighted self-confidence as one of the outcomes of professional development. Continuous professional development plays a vital role in improving competence, expanding knowledge, and fostering professionalism in nursing care delivery. It serves as a pathway for enhancing nurses’ competence [ 29 ].

Hayter et al. conducted a study on nurses’ experiences during natural disasters, which also reported an increase in self-confidence among nurses after their involvement in such events, corresponding with the findings of our study. Nurses in that study demonstrated improved competence in their caregiving role, leading to a greater sense of satisfaction compared to their counterparts [ 1 ].

A unique finding in this study was the enthusiasm and motivation of nurses to provide assistance despite the challenges they faced during disasters. Uzunbacak et al. also found in their study that nurses’ commitment to people and their profession served as a driving force that propelled them to the front lines of disasters [ 30 ]. From this perspective, nurses emerge as invaluable angels who shoulder the immense burden of disasters with unwavering commitment. Beyond their roles within hospitals, they faced the devastating consequences and colossal loss of life. Their efforts to remain strong for patients, themselves, and others in terrifying environments revealed their resilience, sense of duty, and willingness to make sacrifices. Consequently, it becomes evident that the positive consequences of nurses’ presence during disasters and their pursuit of competencies are interconnected like links in a chain, with each aspect contributing to the improvement of the others.

During disasters, the social standing of nurses elevates due to their crucial role in response and care. Their continuous presence and application of specialized knowledge and skills to mitigate health risks establish them as dependable responders [ 31 ]. As a result, their dedication, compassion, and unwavering commitment to patient care, even in the face of challenging circumstances, can enhance the public perception of them.

The participants in this study shared their firsthand experiences of suffering from physical injuries, either themselves or their colleagues, as a result of being present during disasters. In line with the findings of the current study, a qualitative study revealed that nurses often sustained physical injuries during disasters due to inadequate rest, improper nutrition, and insufficient fluid intake [ 32 ]. Additionally, Kim et al. highlighted that provision of care for extended hours, the physical burden and fatigue resulted from excessive workloads [ 33 ]. Furthermore, another study explored the effects of stress on nurses’ physical health during disasters. Stress frequently manifested in digestive problems, muscle pain, fatigue, headaches, sleep disturbances, and even led to the use of sleeping pills, antidepressants, and pain killers [ 34 ].

Psychological injuries experienced by nurses during disasters can significantly impact their ability to work, leaving them unmotivated and unhappy. Various studies have demonstrated that nurses often encounter psycho-emotional disorders and a wide range of problems during such events [ 1 , 35 ]. These challenges can severely disrupt the delivery of high-quality care.

One of the common consequences experienced by nurses during disasters is a sense of hopelessness and the feeling of being unable to effectively treat and assist those in need. Providing care during disasters becomes exceptionally difficult [ 36 ], which has resulted in nurses feeling dissatisfied with their roles, aligning with the findings of our study. In a study by Scrymgeour, participants highlighted the lack of organizational support during disasters as a major source of frustration. They described feeling abandoned by managers and experiencing a lack of presence and availability during disasters, which they perceived as a lack of organizational support. These conditions contributed to feelings of despair and hopelessness [ 37 ].

However, it is important to note that nurses in Iran prioritize motivational factors such as trust in and seeking help from God when attending to disasters due to the religious beliefs prevalent in the country. Therefore, despite the lack of support, their greatest source of disappointment was feeling inadequate in providing the highest quality assistance. This study also revealed that nurses experienced feelings of discontinue from supports during the COVID-19 pandemic and encountered difficulties when interacting with relatives, friends, and society. They exhibited symptoms of depression, anxiety, loneliness, self-doubt, and a lack of self-worth. According to the findings of Kackin et al., fear, uncertainty, and stigma are common in biological disasters. The nurses in their study not only worried about the deterioration of their physical and mental health but also feared transmitting the virus to their families, friends, and others around them, leading them to prefer isolation [ 38 ]. As a result, nurses, who were hailed as heroes, faced stigmatization by certain segments of society due to the perceived potential for transmitting the virus.

In the present study, nurses sometimes experienced disruptions in their family relationships due to the demands of their work. The challenges nurses face in balancing their family responsibilities and work obligations during disasters can lead to conflicts and difficulties [ 1 , 39 ]. It is crucial for managers to create a supportive environment for nurses’ families, as this can contribute to improved mental health and reduced concerns among nurses.

Studies have also indicated an increase in violence against nurses during critical situations and disasters, which is consistent with the findings of the present study [ 40 , 41 ]. Limited interaction with family and work schedules that interfere with family responsibilities can heighten the risk of family tensions for nurses [ 42 ]. When nurses are unable to participate in family events or spend quality time with their loved ones, it can lead to decreased job performance and increased stress [ 43 ]. To address these conflicts, healthcare organizations and policymakers should implement strategies such as providing flexible work schedules, offering counseling services, and providing financial and welfare support to nurses’ families during disasters. Additionally, nurses should be encouraged to develop coping mechanisms and self-care strategies that help them balance their work and family responsibilities.

Nurses reported experiencing various forms of violence during disasters, including violence from service recipients, managers, colleagues, doctors, and society. These types of violence against nurses have been highlighted as important concerns in other studies as well [ 42 , 44 ]. Of course, the presence of nurses during disasters can help them in emotional management by increasing their preparedness and strengthening their resilience. Therefore, presence during disasters can bring benefits for nurses [ 37 ].

The findings of this study reveal that nurses who are present during disasters face a range of both negative and positive consequences. These consequences can impact their physical, psychological, social, professional, and familial well-being. Furthermore, these consequences can have significant effects on patients, managers, and the overall health system. Understanding the implications of nurses’ presence during disasters is crucial for healthcare managers. It enables them to recognize and implement the necessary programs and interventions to prevent negative consequences and promote positive and desirable outcomes for all stakeholders involved.

Limitations

The findings of this study provide valuable insights into the experiences and perspectives of nurses in southeastern Iran. However, to generalize these findings and apply them to nursing practice more broadly, it is important to validate them through studies involving other nursing populations. Conducting further research in different regions and contexts will enhance the robustness and generalizability of the results.

Nevertheless, this study offers a rich and comprehensive description of the consequences of nurses’ presence during disasters and their commitment to acquiring competencies. It contributes to the existing knowledge of nursing in Iran and can also serve as a valuable resource for understanding the experiences of nurses in other regions.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Xue CL, Shu YS, Hayter M, Lee A. Experiences of nurses involved in natural disaster relief: a meta-synthesis of qualitative literature. J Clin Nurs. 2020;29(23–24):4514–31.

Article   PubMed   PubMed Central   Google Scholar  

Rodriguez-Arrastia M, García‐Martín M, Villegas‐Aguilar E, Ropero‐Padilla C, Martin‐Ibañez L, Roman P. Emotional and psychological implications for healthcare professionals in disasters or mass casualties: a systematic review. J Nurs Adm Manag. 2022;30(1):298–309.

Article   Google Scholar  

Said NB, Chiang VC. The knowledge, skill competencies, and psychological preparedness of nurses for disasters: a systematic review. Int Emerg Nurs. 2020;48:100806.

Article   PubMed   Google Scholar  

Emaliyawati E, Ibrahim K, Trisyani Y, Mirwanti R, Ilhami FM, Arifin H. Determinants of nurse preparedness in disaster management: a cross-sectional study among the community health nurses in coastal areas. Open Access Emerg Med. 2021:373–9.

Songwathana P, Timalsina R. Disaster preparedness among nurses of developing countries: an integrative review. Int Emerg Nurs. 2021;55:100955.

Akbari K, Yari A, Ostadtaghizadeh A. Nurses’ experiences of providing medical services during the Kermanshah earthquake in Iran: a qualitative study. BMC Emerg Med. 2024;24(1):4.

Farokhzadian J, Mangolian Shahrbabaki P, Farahmandnia H, Taskiran Eskici G, Soltani Goki F. Nurses’ challenges for disaster response: a qualitative study. BMC Emerg Med. 2024;24(1):1.

Civljak M, Stivic I, Puljak L. Secondary traumatic stress in working nurses studying part time in a bachelor or Master’s nursing program in Croatia: a cross-sectional study. BMC Nurs. 2024;23(1):1–8.

Vagni M, Maiorano T, Giostra V, Pajardi D. Coping with COVID-19: emergency stress, secondary trauma and self-efficacy in healthcare and emergency workers in Italy. Front Psychol. 2020;11:566912.

Wang W, Li H, Huang M. A literature review on the impact of disasters on healthcare systems, the role of nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations. Front Oncol. 2023;13:1178092.

Coombs NM, Porter JE, Barbagallo M, Plummer V. Public health messaging during disasters: practice and attitudes of Australian emergency nurses. Australasian Emerg Care. 2023;26(2):193–7.

Alharbi NS, Youssef HA, Felemban EM, Alqarni SS, Alharbi NM, Alsayed AAO, et al. Saudi emergency nurses preparedness for biological disaster management at the governmental hospitals. J Posit School Psychol. 2022;6(9):1218–35.

Google Scholar  

Ma H, Huang J, Deng Y, Zhang Y, Lu F, Yang Y, et al. Deployment experiences of military nurses: a systematic review and qualitative meta-synthesis. J Nurs Adm Manag. 2021;29(5):869–77.

Hines SE, Chin KH, Glick DR, Wickwire EM. Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(2):488.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Gustavsson ME, Juth N, Arnberg FK, von Schreeb J. Dealing with difficult choices: a qualitative study of experiences and consequences of moral challenges among disaster healthcare responders. Confl Health. 2022;16(1):1–19.

Curtis K, Fry M, Shaban RZ, Wolf L, Delao A, Kolbuk ME, et al. Emergency nurses’ perceptions of the utility, adaptability and feasibility of the emergency nursing framework HIRAIDTM for practice change in US: an exploratory study. Int Emerg Nurs. 2023;71:101377.

Ozdemir SC, Ziyai NY, Cakir E. Experiences of intensive care nurses providing care to the victims of Kahramanmaraş earthquakes. 2023.

Ying W, Yu L, Mingfeng Y, Hui W, Chaohua P, Zhang P, et al. Disaster preparedness among nurses in China: a cross-sectional study. J Nurs Res. 2023;31(1):e255.

Schreier M, Stamann C, Janssen M, Dahl T, Whittal A. Qualitative content analysis: Conceptualizations and challenges in research practice. 2019.

Sandelowski M. Whatever happened to qualitative description? Research in nursing & health. 2000;23(4):334 – 40.

Anney VN. Ensuring the quality of the findings of qualitative research: looking at trustworthiness criteria. J Emerg Trends Educational Res Policy Stud. 2014;5(2):272–81.

Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Program Evaluation. 1986;1986(30):73–84.

Zaitoun RA, Said NB, de Tantillo L. Clinical nurse competence and its effect on patient safety culture: a systematic review. BMC Nurs. 2023;22(1):173.

Ma H, Chihava TN, Fu J, Zhang S, Lei L, Tan J, et al. Competencies of military nurse managers: a scoping review and unifying framework. J Nurs Adm Manag. 2020;28(6):1166–76.

Pourhosseini SS, Ardalan A, Mehrolhassani MH. Key aspects of providing healthcare services in disaster response stage. Iran J Public Health. 2015;44(1):111.

PubMed   PubMed Central   Google Scholar  

Brooks SK, Dunn R, Amlôt R, Rubin GJ, Greenberg N. Protecting the psychological wellbeing of staff exposed to disaster or emergency at work: a qualitative study. BMC Psychol. 2019;7:1–11.

Allobaney NF, Eshah NF, Abujaber AA, Nashwan AJ. Professional self-concept and self-confidence for nurses dealing with COVID-19 patients. J Personalized Med. 2022;12(2):134.

Joy GV, Alomari AMA, Singh K, Hassan N, Mannethodi K, Kunjavara J, et al. Nurses’ self-esteem, self‐compassion and psychological resilience during COVID‐19 pandemic. Nurs Open. 2023;10(7):4404–12.

Jeong S, Lee O. Correlations between emergency code awareness and disaster nursing competencies among clinical nurses: a cross-sectional study. J Nurs Adm Manag. 2020;28(6):1326–34.

Uzunbacak HH, Yastıoğlu S, Dik BJ, Erhan T, Akçakanat T. Changes in nurses’ sense of calling during the COVID-19 pandemic: a qualitative study. J Career Dev. 2023;50(3):709–26.

Firouzkouhi M, Kako M, Abdollahimohammad A, Balouchi A, Farzi J. Nurses’ roles in nursing disaster model: a systematic scoping review. Iran J Public Health. 2021;50(5):879.

Yuwanich N, Sandmark H, Akhavan S. Emergency department nurses’ experiences of occupational stress: a qualitative study from a public hospital in Bangkok, Thailand. Work. 2016;53(4):885–97.

Kim H-R, Yang H-M. Nursing experience during COVID-19 pandemic in Korea: a qualitative analysis based on critical components of the professional practice models. BMC Nurs. 2022;21(1):288.

Naushad VA, Bierens JJ, Nishan KP, Firjeeth CP, Mohammad OH, Maliyakkal AM, et al. A systematic review of the impact of disaster on the mental health of medical responders. Prehosp Disaster Med. 2019;34(6):632–43.

Dehkordi AH, Tali SS, Gheshlagh RG. The experiences of Iranian nurses in critical events and natural disasters: a qualitative study. Qualitative Rep. 2021;26(9):2872–81.

Dhavale P, Koparkar A, Fernandes P. Palliative care interventions from a social work perspective and the challenges faced by patients and caregivers during COVID-19. Indian J Palliat Care. 2020;26(Suppl 1):S58.

Scrymgeour GC, Smith L, Maxwell H, Paton D. Nurses working in healthcare facilities during natural disasters: a qualitative enquiry. Int Nurs Rev. 2020;67(3):427–35.

Article   CAS   PubMed   Google Scholar  

Kackin O, Ciydem E, Aci OS, Kutlu FY. Experiences and psychosocial problems of nurses caring for patients diagnosed with COVID-19 in Turkey: a qualitative study. Int J Soc Psychiatry. 2021;67(2):158–67.

Kimin A, Nurachmah E, Lestari F, Gayatri D. Factors affecting nurses’ ability to provide effective care in a disaster response: a review. Journal of public health research. 2022;11(2):jphr. 2021.732.

Fink AM, Milbrath GR. A concept analysis of nurses in conflicts after World War II. J Adv Nurs. 2023;79(1):31–47.

Ebrahimi Rigi Z, Mangolian Shahrbabaki P, Ahmadi F, Ravari A. Self-sacrifice in a distressful and threatening environment: the consequences of the COVID-19 crisis in intensifying workplace violence. Front Psychiatry. 2022;13:848059.

Vieira-Meyer APGF, Ferreira RGLA, Albuquerque GA, Guimarães JMX, Morais APP, Meyer CHC, et al. Gender and violence in the daily routine of community health workers in Fortaleza, Brazil. J Community Health. 2023;48(5):810–8.

Dilmaghani RB, Armoon B, Moghaddam LF. Work-family conflict and the professional quality of life and their sociodemographic characteristics among nurses: a cross-sectional study in Tehran, Iran. BMC Nurs. 2022;21(1):289.

Jiang J, Han P, Huang X, Liu Y, Shao H, Zeng L, et al. Post-traumatic growth experience of first-line emergency nurses infected with COVID-19 during the epidemic period—A qualitative study in Shanghai, China. Front Public Health. 2022;10:1015316.

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FSG and JF have made substantial contributions to the conception and design of the study, and taken responsibility for and coordinated the acquisition of data, which they gathered and analyzed. they took part actively in the analysis of the data, in its abstraction and in the writing-up of the manuscript. HF and PMSH contributed to the conception and design of the study. HF was involved in the data collection process and took an active part in the data analysis and results interpretation. PMSH and GTE also took part in the writing-up and finalization of the manuscript. GTE, JF, FS and HF contributed to the study design, data acquisition, results interpretation and writing-up of the manuscript. All authors read and approved the final manuscript.

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At the request of the ethics committee, the present study was conducted under the Declaration of Helsinki and the Committee on Publication Ethics (COPE). To observe ethical considerations, the participants were provided with comprehensive information about the study goals and process. All participants provided written informed consent in all stages of the study. The participants were voluntarily enrolled, and they could withdraw from the study at any time. No names were written down or mentioned during the interviews. The interview recordings were deleted after transcription. The interviewees’ and the respondents’ confidentiality was maintained throughout the research process from data collection to publication.

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Farokhzadian, J., Shahrbabaki, P.M., Farahmandnia, H. et al. Exploring the consequences of nurses’ involvement in disaster response: findings from a qualitative content analysis study. BMC Emerg Med 24 , 74 (2024). https://doi.org/10.1186/s12873-024-00994-z

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Professional attractiveness among long-term care workers in nursing homes in China: a cross-sectional study

• Xiaojing Qi 1   na1 ,
• Ziyan Dong 2   na1 ,
• Wen Xie 2 ,
• Liuqing Yang 2 &

BMC Health Services Research volume  24 , Article number:  548 ( 2024 ) Cite this article

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The population aging trend and the shortage of elderly care workers require the long-term care profession to become more attractive. However, the professional attractiveness among long-term care workers has yet to be extensively studied. This study aims to identify the factors that influence the attractiveness of the long-term care profession for nursing home (NH) care workers..

A cross-sectional study was conducted in more than 50 NHs. Perception of professional attractiveness among long-term care workers and potential associated factors were measured using the Attractive Work Questionnaire (AWQ) and structural instruments including the Fraboni Scale of Ageism (FSA) and the Maslach Burnout Inventory (MBI). A multiple linear regression method was employed to explore the influence of potential independent variables on professional attractiveness.

The overall response rate was 99%. The results showed the score of professional attractiveness (185.37 ± 20.034), as well as the scores of each component (99.26 ± 11.258 for work condition, 30.13 ± 3.583 for work content, and 55.99 ± 7.074 for job satisfaction). Findings of multiple linear regression analysis indicated that age( β = 0.129, p<.05 ), years of work( β = 0.156, p<.05 ), 12-hour shifts( β = 0.185, p<.05 ), and training times per year( β = 0.148, p<.05 ) positively associated with long-term care workers perceived professional attractiveness. Whereas only ageism( β=-0.267, p<.05 ) significantly and negatively influenced professional attractiveness.

Conclusions

The perceived professional attractiveness of long-term care workers in NHs was acceptable. Age, years of work, shifts, training opportunities, and ageism contributed to the professional attractiveness of nursing home care workers in China. Target intervention measures should be taken to enhance the attractiveness of long-term care careers so as to avoid the shortage of long-term care workers.

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Population aging has become an inevitable trend that could pose serious health challenges worldwide. The proportion of older persons in the world is anticipated to increase from the current level of 9% to nearly 16% by 2050, with 1.6 billion older people [ 1 ]. According to the National Bureau of Statistics of China data [ 2 ], the number of elderly adults aged 60 years and over reached 264 million in 2020, accounting for 18.7% of the total Chinese population. Elderly people experience a decline in cognition and function as they age, threatening independence. An estimated 47 million disabled or semi-disabled older adults live in China in 2020 [ 3 ]. Hence, there is an urgent need to develop long-term care (LTC) to address the challenges of aging and rising disabled populations.

LTC refers to care provided by carers or care workers for individuals with declines in intrinsic capacity or functional ability, which can last for an extended period [ 4 ]. LTC services generally occur in non-institutional settings such as homes and communities or institutional settings such as LTC facilities (i.e., nursing homes (NHs)). China’s long-term care service system consists of three main types of services: home-based, community-based, and institution-based, and shows a pattern of “9073”, namely, 90% of the elderly ageing at home, 7% receiving community-based services and 3% receiving institutionalized services [ 5 ]. Home care, with family members as the primary caregivers, has long been the traditional mode of care in China [ 6 ]. However, decreased fertility rates, shrinking family sizes, and frequent internal immigration from rural to urban have shifted China’s traditional family-based care model for the elderly to the current trend toward greater reliance on NHs [ 7 ].

The development of NHs faces several challenges, including low staffing ratios and high staff turnover combined with low salaries and unfavorable social attitudes toward LTC workers [ 8 ]. The National Occupational Standard for Elderly Caregivers (2011), formulated by China’s Ministry of Labor and Social Security, stipulates that the occupation of elderly care workers has four grades: junior, intermediate, senior and technician. Subsequently, in the 2019 revision, the entry requirements for elderly care workers have been further relaxed to meet the challenge of a lack of elderly caregivers, and the number of years of experience required for the promotion of care worker professional qualifications has been shortened. The new standard adjusts the educational requirement for care workers from “graduation from junior high school” to “no educational requirement”; and adjusts the declaration requirement for junior workers is adjusted from “more than 2 years of continuous apprenticeship in this occupation” to “more than 1 year (inclusive) of cumulative work in this occupation or related occupations”. For caregivers who have already obtained the intermediate elderly care worker vocational qualification certificate and want to obtain the senior vocational qualification, the number of years of employment required has been reduced from 4 to 2 years [ 9 ]. Most long-term care workers in NHs are middle-aged women with low education levels and hardly accept formal pre-employment training [ 10 , 11 , 12 ]. Moreover, it is frustrating that students and skilled nurses show a somewhat sluggish interest in devoting themselves to LTC [ 13 , 14 ]. Previous studies examining the quality of LTC facilities have shown that many problems are linked to caregiver shortages, such as falls, pressure ulcers, and medication errors [ 15 ]. The shortage of skilled care workers reduces a unit’s ability to meet the diverse nursing requirements of the aged for physical, psychological, and rehabilitation.

The definition of professional attractiveness varies across different occupations and lacks consistency in the literature. Ateg defines “attractive work” as work that possesses positive characteristics and attracts the attention of job seekers and current employees in a positive manner [ 16 ]. Professional attractiveness of long-term care workers had previously been described based on the Walker and Avant’s classical concept analysis method [ 17 ]. The definition is that LTC facilities possess the ability to attract excellent staff, not only in terms of eliciting the willingness of potential applicants to work but in terms of retaining and motivating the current long-term care workers. According to our interpretation, professional attractiveness also reflects a psychological tendency of employees working in LTC facilities, which was driven by the work experiences and perceptions (e.g. satisfaction, turnover intention, and burnout) that various job features bring to employees.

The experience of work tends to be affected on many levels. Previous studies have demonstrated numerous individual characteristics, such as age, health status, working years, and education levels, could influence long-term care workers’ job satisfaction and turnover intention [ 18 , 19 ]. Staff participation in supportive management had a positive relationship with their job satisfaction in LTC facilities [ 20 ], which might endow care workers with more confidence and sense of accomplishment. Besides, several organizational factors have been reported that might exert an influence on job satisfaction and turnover intention. Foa found that positive relationships with colleagues and training favor job satisfaction, while workload, lack of training, and reduction of rest time create dissatisfaction and even increase burnout [ 21 ]. Lee et al. reported that several work conditional factors like wage, working hours, and working intensity influence the turnover intention of home care workers [ 22 ]. Additionally, intrapersonal factors, including ageism, burnout, and mood, have been associated with job satisfaction and intention to leave directly or indirectly. Ageism, referring to the prejudice of one age group against another [ 23 ], is associated with LTC workers’ intention to leave and plays a mediating role in job satisfaction and intention to stay [ 24 ]. Actually, discrimination against the aged based on age, resources, and contribution leads to a negative image of geriatric nursing [ 25 ]. White found that those nurses who work in LTC facilities with higher burnout were more likely to leave their jobs [ 26 ]. It appears that burnout would make LTC less attractive. Long-term care workers who are dissatisfied with their current job situation or even have a desire to leave may perceive that their job has become less desirable.

There have been some studies exploring job attractiveness in the healthcare profession [ 27 , 28 ], indicating that determinants of professional attractiveness are work engagement and age. However, few studies probed into professional attractiveness in long-term care workers directly. This study aimed to investigate the status of professional attractiveness among long-term care workers working in NHs in China using structural questionnaires and explore the impact of potential factors on it. We hypothesized that demographics, job security factors (including wage and training), and individual subjective factors (including job burnout and ageism) would affect long-term care workers’ professional attractiveness.

Study design and participants

This was a cross-sectional descriptive study conducted from June 2021 to June 2022. The sample size was grossly calculated based on the requirement of a multiple linear regression model, in which cases should be more than 5–10 times the number of independent variables [ 29 ]. The number of independent variables in this study was 15 and considering 10% invalid questionnaires, the required sample size should be 83–165 at least. The inclusion criteria for the current study were as follows: (1) care workers who work in NHs and take care of the elderly directly, (2) have worked in LTC facilities for at least three months, and (3) are volunteered to participate in this survey. The participants were excluded if they were: (1) unable to complete the questionnaire or (2) reluctant to participate in the study.

Data collection

The study was approved by the ethics committee of Huazhong University of Science and Technology. Subjects were selected using a convenience sampling strategy from 57 NHs in Wuhan, Hubei Province, and Kaifeng, Henan Province, China. All participants were informed about the content and purpose of the study in detail and signed an informed consent form. Structural questionnaires were delivered to participants on-site by trained investigators, and confidentiality was emphasized. We recruited 396 care workers and the responsiveness of the sample was 99%.

Variables and measurements

Independent variables, demographics and job institutional security factors.

Long-term care workers’ basic demographics and job security data were obtained using a questionnaire designed by researchers, which included age, marital status, gender, education, employment form, working years, certificate level, shift mode, number of care objects, number of care objects with a disability, and whether to participate in management. Income and training opportunities belong to job security.

The Fraboni scale of ageism (FSA) was used to measure cognitive and affective aspects of ageism [ 30 ]. The FSA consists of 29 items related to three dimensions of counterstatement, avoidance, and denial. Each item is evaluated on a Likert scale from 1 (definitely do not agree) to 4 (definitely agree), with higher scores suggesting greater ageism. The Chinese version of the FSA was revised previously and confirmed as a valid and reliable tool among medical students with a Cronbach’s alpha of 0.81 and a content validity of 0.93 [ 31 ]. To ensure accurate results, we have verified the reliability of FSA in long-term care workers with a Cronbach’s alpha of 0.856 and a KMO value of 0.786.

Job burnout

The Maslach Burnout Inventory (MBI) is one of the best-known tools for evaluating job burnout, which consists of three dimensions of emotional exhaustion, depersonalization, and personal accomplishment [ 32 ]. The Chinese version of MBI adapted by Li et al. [ 33 ] has been used widely and was constitutive of 15 items on a 7-point Likert scale ranging from 1 (never) to 7 (every day). The overall reliability of MBI in long-term care workers is acceptable with a Cronbach’s alpha of 0.882.

• Professional attractiveness

The Attractive Work Questionnaire (AWQ), created by Ateg and Hedlund [ 34 ], was used to assess employees perceived professional attractiveness. For the purpose of the study, the Chinese version was used to assess the professional attractiveness of long-term care workers in the Chinese context after cross-cultural adjustment. The revised AWQ has 46 items, including three areas of work conditions, work contents, and job satisfaction. All items were rated on a 5-point Likert scale ranging from not at all to entirely , with higher scores indicating that the job is more attractive to the employee. The Cronbach’s alpha of the three components of the Chinese version of AWQ ranges from 0.816 to 0.920, indicating good reliability. As well as the KMO values of the three components are 0.822, 0.685, and 0.848 respectively, indicating good validity.

Statistical analysis

Standard descriptive statistics were used to describe participants’ characteristics. Mean values and standard deviation (SD) (for symmetric distribution) or median and quartiles (for skewed distribution) were calculated for continuous variables, while frequency and percentage were used for categorical variables. We generated the mean total score for professional attractiveness and the mean score for each domain. A series of Spearman’s correlation coefficients, the Wilcoxon rank-sum test, and the Kruskal-Wallis H test were calculated to examine the association between demographics, job-related characteristics, ageism, burnout, and professional attractiveness. When the p-value was less than 0.05, it was considered to be statistically significant. The multiple linear regression method was employed to analyze the influence of many variables that were significant in the univariable analysis of professional attractiveness. All of the data were analyzed by the SPSS, version 24.0.

Characteristics of sample

Table  1 showed the summary characteristics of the long-term care workers. The participants’ age ranged between 18 and 74 years. We found that most workers were middle-aged and had been working in LTC services for 3–7 years according to analysis. The overwhelming majority of the long-term care workers included in the analysis were female (89.3%), married (87.8%), and with a degree below associate (73%). The proportion of contract (49%) and temporary (51%) workers was comparable. Merely about one-fifth of the care workers in the sample had intermediate or advanced professional qualifications for elderly care workers. About half of the workers (47.4%) work eight-hour shifts and only around one-third of the staff are involved in management. Results indicated that the typical ageism scores ranged from 51 to 63 on a total score of 129, and the typical job burnout scores ranged from 45 to 55 on a total score of 105 in participants.

The professional attractiveness of long-term care workers

Table  2 showed the results of the analysis for the AWQ questionnaire regarding the three aspects of professional attractiveness: work conditions, work contents, and job satisfaction. The total mean score for the AWQ was 185.37 ± 20.034 points, among which the score of work condition, work content, and job satisfaction was 99.26 ± 11.258, 30.13 ± 3.583 and 55.99 ± 7.074, respectively. The sub-dimensional statistical results are shown in Table  2 , respectively.

Predictors of long-term care workers perceived professional attractiveness

Spearman correlation, Mann-Whitney U test, and Kruskal-Wallis H test were used to examine the professional attractiveness related to all variables and the results are shown in Table  3 . In terms of demographics, the results showed that the differences in total professional attractiveness score by age, marital status, gender, education level, employment mode, years of work experience, nursing assistant certificate level, shift status, average daily care number, and average daily care disabled number were statistically significant ( p  < .05).

As for job institutional security and subjective perception factors, it was discovered that the more salary ( r  = .139, p  = .006) and training opportunities ( r  = .226, p  = .000) a long-term care worker gets and the higher perceived professional attractiveness, and the higher ageism in long-term care workers is associated with lower professional attractiveness ( r =-.315, p  = .000). However, there was no significant relationship between job burnout and professional attractiveness.

Five significant variables in univariate analysis were entered into the regression equation and accounted for 26.9% of the variance in the scores of professional attractiveness.

As shown in Table  4 , age( β  = 0.129, p <.05), years of work experience( β  = 0.156, p <.05), and 12-hour shifts( β  = 0.185, p <.05) were found to have a positive relationship with long-term care workers perceived professional attractiveness. Training times per year( β  = 0.148, p <.05), the only significant job institution security factor, was positively associated with the professional attractiveness. Whereas the ageism is higher for decreasing professional attractiveness total score( β =-0.267, p <.05).

The present study has been the first to quantitatively describe the professional attractiveness among long-term care workers who work in NHs and explore the determinants from multiple aspects, such as job institutional security and subjective perception.

In this study, the culturally adapted AWQ was first used to evaluate the professional attractiveness of long-term care workers. Compared with the mean score of the whole questionnaire and each component, the findings suggested that the overall perceived professional attractiveness, as well as each component, were superior among long-term caregivers, which indicated that NH care workers find their profession as a decent attraction. This result was similar to previous study. Liu et al. employed a self-designed questionnaire on the attractiveness of the elderly care service talents and found that the attractiveness of elderly caregivers was generally acceptable [ 35 ]. Similarly, studies have shown that in the United States, low-income older workers report that working in long-term care is attractive. However, they preferred to work in a home environment compared to a nursing home or other institutional setting [ 36 ]. However, the results of another study suggest that care workers in LTC facilities do not rate their jobs highly due to low wages and intense job content [ 37 ]. Long-term care workers in Chinese NHs tend to be middle-aged and older women who have retired, been laid off, or migrated to cities to work, it is not easy to find a suitable job [ 38 ]. In the 1990s, many workers in state-owned factories were laid off in the course of market reforms and were left in a precarious situation due to the lack of re-employment programs. Many of these workers entered the care sector as a last resort due to the high demand and low barriers to employment in the care sector in urban areas [ 39 ]. They are satisfied with possessing a job, so that the LTC industry is relatively more desirable to them. Besides, the flexible shifts in NHs allow care workers relative freedom to arrange their own time, which might be sufficient for long-term care workers to have a better appreciation of their work.

Our study found that long-term care workers who are older and have longer working years perceived higher professional attractiveness. These findings are consistent with previous studies [ 40 ]. This may be attributable to the fact that care workers in NHs who are older and with longer work tenure already have a wealth of theoretical knowledge and practical solid ability to care for the elderly and are familiar with to work environment and content.

Besides, higher professional attractiveness is obtained when long-term care workers on 12-hour shifts compared to 8-hour shifts. Previous literature points out that when wards are on 12-hour nursing shifts, there is even decreased turnover intention in the LTC industry [ 41 ], which is similar to our findings. Whereas other studies indicated that longer shifts are associated with job burnout, dissatisfaction, and turnover intention [ 42 ]. This may endorse that too frequent shifts make it difficult for care workers in NHs to balance their work and life. Along with the disruption of circadian rhythms, short shifts in LTC facilities tend to prevent the formation of everyday routines and even lead to work-family conflict among care workers [ 10 ]. While working too many hours in a row easily fatigues employees and increases the risk of work errors, which could bring unpleasant experiences to care workers [ 43 ].

According to our study, long-term care workers who receive more training opportunities per year perceive greater attractiveness. Similarly, previous studies reported that the absence of training to enhance professionalism, as a characteristic of elderly care work, is associated with turnover [ 44 ]. The lack of professional training leaves care workers with less expertise in caring for the elder with or without disability or dementia, which puts them under tremendous pressure practically and psychologically. As a result, care workers may be dissatisfied with work condition nursing homes provided and even think about leaving their job, indicating that a career in LTC is no longer attractive to them [ 11 ]. Instead, training facilities capacity enhancement and increases accomplishment, which is an essential factor affecting work enthusiasm [ 45 ]. It has been suggested that satisfying the needs of knowledge acquisition of health professionals involved in the care of older adults is helpful in increasing work engagement and reducing job burnout [ 46 ]. The lack of professionalism and preparedness among care workers in long-term care sector reinforced the importance of training to create more promotion opportunities [ 40 ].

Additionally, our findings suggest that there is a decrease in professional attractiveness when care workers in NHs exhibit higher ageism. Ageism as a stereotype is prevalent in LTC facilities, and it may be linked to cognitive prejudice resulting from the low qualifications and dissatisfaction caused by low wages among LTC workers [ 47 , 48 , 49 ]. Age-based discrimination from care workers lead to decreased quality of care as well as psychological distress for the elderly [ 50 ]. LTC workers showing high levels of ageism tend to be reluctant to stay with and provide comprehensive care to older people, indicating that their jobs become less appealing and desirable [ 24 ].

Limitations

This study has several limitations. Firstly, participants were selected only from two cities in China, which could introduce potential bias due to regional disparity and limit the generalizability of our results. Another important limitation is that the study did not consider the potential influence of varying characteristics of LTC facilities (e.g. business nature of LTC facilities), which could lead to incomplete results. Besides, the current study was conducted in the midst of the COVID-19 epidemic, and previous studies have demonstrated that changes in patterns of care brought about by COVID-19 epidemics can increase the workload of nursing home care workers [ 51 ]. In contrast, our findings cannot exclude the impact of the epidemic on the perceived professional attractiveness of nursing home care workers, which also implies that further investigations are necessary during non-epidemic periods. Additionally, it is impossible to establish causality due to the cross-sectional design.

Implications

Measures such as developing professional education programs, lowering entry barriers, and providing monetary incentives have all been taken by the Chinese government in order to attract talent and solve the problem of labor shortage [ 52 ]. However, to maximize the attractiveness and retention of talent in the elderly care industry while improving the quality of care of LTC facilities, these measures are far from sufficient.​ By exploring the potential influences on the perceived professional attractiveness of long-term care workers, the current study provides a direction for policymakers and managers of long-term care institutions to consider improvements. Training programs, not only on nursing skills but also on knowledge of aging, should be prioritized to improve the ability of care workers to provide quality care and to mitigate ageism, potentially reversing unattractive career prospects. This will require greater government investment in education and training, as well as monitoring of the effective implementation of policies in LTC facilities. Additionally, managers of LTC institutions should consider a series of effective coping and managing mechanisms to attract talent. Career promotion systems and incentive mechanisms that go beyond the traditional ones should be put in place, with pay scales set according to the level of vocational skills qualification, years of experience, and working performance, to enhance the enthusiasm of elderly care workers. We have highlighted the importance of suitable working hours for ensuring care workers that are more likely to behave in high efficiency. Hence, administrators should optimize shift settings and try to avoid employees working too long hours in a row, maximizing job satisfaction of care workers while ensuring the quality of care, which in turn increases their perceived professional attractiveness.

Future research should include larger cross-regional samples and longitudinal studies to further verify relevant predictors and examine relationships across time. Besides, other LTC settings beyond nursing homes need to be considered, such as LTC hospitals. Additionally, future studies should explore professional attractiveness of long-term care workers from a qualitative perspective.

This study examines the current state of professional attractiveness among LTC care workers in nursing homes. It also assessed the factors associated with professional attractiveness. This study provides insight into the plight faced by China’s LTC industry and strategies to improve the attractiveness of LTC industry to retain and appeal to healthcare professionals.

Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Nursing Home

Long-term Care

Fraboni Scale of Ageism

The Attractive Work Questionnaire

The Maslach Burnout Inventory

United Nations, Department of Economic and Social Affairs, Population Division. (2019): World Population Prospects 2019: Highlights (ST/ESA/SER.A/423).; 2019.

National Bureau of Statistics of China. Communiqué of the Seventh National Population Census (No. 5). http://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/202302/t20230206_1902005.html . Accessed 6 May 2023.

Ge Y, Wang L, Feng W, Zhang B, Liu S, Ke Y. The challenge and strategy selection of healthy aging in China. J Manage World. 2020;36(04):86–96.

Google Scholar  

Perracini MR, Arias-Casais N, Thiyagarajan JA, Rapson C, Isaac V, Ullah S, Hyobum J, Sadana R, Han ZA. A recommended Package of Long-Term Care services to promote healthy ageing based on a WHO Global Expert Consensus Study. J AM MED DIR ASSOC. 2022;23(2):297–303.

Article   PubMed   Google Scholar  

Wan H, Wang Y, Fang L, Tao L, Li S, Yang Y, Yang C. Study on integrated health care under institution-community-home endowment mode. Chin Health Resour. 2018;21(01):61–6.

Chen L, Zhang X, Xu X. Health Insurance and Long-Term Care Services for the disabled Elderly in China: based on CHARLS Data. RISK MANAG HEALTHC P. 2020;13:155–62.

Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H, Aman Y, Frank J, Liao J, Zou H et al. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. AGEING RES REV 2020, 64:101174.

Wang L. A study on the Development of China’s Nursing Home Services in Urban Area. Popul J. 2014;36(04):83–92.

Two Departments Promulgate and Implement the National Occupational Skills Standard for Elderly Caregivers. (2019 Edition). https://www.gov.cn/xinwen/2019-10/17/content_5440977.htm . Accessed 8 April 2024.

Hauser C, Stahl J, Simon M, Valenta S, Favez L, Zuniga F. Identifying work-related factors associated with work-family conflict of care workers in nursing homes: a cross-sectional study. J ADV NURS 2023.

Pardo-Garcia I, Martinez-Lacoba R, Escribano-Sotos F. Socioeconomic factors related to job satisfaction among Formal Care Workers in nursing homes for older dependent adults. INT J ENV RES PUB HE 2021, 18(4).

Zeng Y, Hu X, Li Y, Zhen X, Gu Y, Sun X, Dong H. The quality of caregivers for the Elderly in Long-Term Care Institutions in Zhejiang Province, China. INT J ENV RES PUB HE 2019, 16(12).

Dai F, Zhang X, Wan Q. Willingness and influencing factors for senior nurses involving in long-term care for the elderly. Chin Gen Pract. 2014;17(24):2880–4.

Darling R, Sendir M, Atav S, Buyukyilmaz F. Undergraduate nursing students and the elderly: an assessment of attitudes in a Turkish university. GERONTOL GERIATR EDU. 2018;39(3):283–94.

Article   Google Scholar  

Rust TB, Wagner LM, Hoffman C, Rowe M, Neumann I. Broadening the patient safety agenda to include safety in long-term care. Healthc Q. 2008;11(3 Spec No):31–4.

Ateg M, Andersson I, Rosen G. Change processes for attractive work in Small Manufacturing companies. Hum FACTORS Ergon Manuf. 2009;19(1):35–63.

Qi X, Wang Q, Zhao H, Kong L, Fan J, Li J. A conceptual analysis of long-term caregivers’ occupational attractiveness. Chin J Mod Nurs. 2022;28(25):3502–7.

Kash BA, Naufal GS, Dagher RK, Johnson CE. Individual factors associated with intentions to leave among directors of nursing in nursing homes. HEALTH CARE MANAGE R. 2010;35(3):246–55.

Aloisio LD, Coughlin M, Squires JE. Individual and organizational factors of nurses’ job satisfaction in long-term care: a systematic review. INT J NURS STUD. 2021;123:104073.

Choi J, Flynn L, Aiken LH. Nursing practice environment and registered nurses’ job satisfaction in nursing homes. GERONTOLOGIST. 2012;52(4):484–92.

Foa C, Guarnieri MC, Bastoni G, Benini B, Giunti OM, Mazzotti M, Rossi C, Savoia A, Sarli L, Artioli G. Job satisfaction, work engagement and stress/burnout of elderly care staff: a qualitative research. Acta Biomed. 2020;91(12–S):e2020014.

PubMed   PubMed Central   Google Scholar  

Lee S, Oh G, Fabius CD, Reckrey JM. Working conditions Affecting Home Care workers’ stress and turnover intention. J APPL GERONTOL. 2023;42(4):717–27.

Butler RN. Age-ism: another form of bigotry. GERONTOLOGIST. 1969;9(4):243–6.

Article   CAS   PubMed   Google Scholar  

Liu CC, Liu LF, Chuang SS. The Effect of Ageist behaviors on Home Care workers’ job satisfaction and Retention in Long-Term Care. J APPL GERONTOL. 2022;41(2):322–31.

Campbell SL. The attractiveness of a career in geriatric nursing. J GERONTOL NURS. 2010;36(6):3.

White EM, Aiken LH, McHugh MD. Registered nurse burnout, Job Dissatisfaction, and missed care in nursing homes. J AM GERIATR SOC. 2019;67(10):2065–71.

Article   PubMed   PubMed Central   Google Scholar  

Ohara Y, Nomura Y, Yamamoto Y, Okada A, Hosoya N, Hanada N, Hirano H, Takei N. Job Attractiveness and Job Satisfaction of Dental Hygienists: From Japanese Dental Hygienists’ Survey 2019. INT J ENV RES PUB HE 2021, 18(2).

Bjorn C, Josephson M, Wadensten B, Rissen D. Prominent attractive qualities of nurses’ work in operating room departments: a questionnaire study. WORK. 2015;52(4):877–89.

Tabachnick BG, Fidell LS. Using multivariate statistics |.*6* 6 . 7th edition. Boston: MA: pearson; 2013.

Fraboni M, Saltstone R, Hughes S. The Fraboni Scale of Ageism (FSA): an attempt at a more precise measure of Ageism. Can J Aging / La Revue Canadienne Du Vieillissement. 1990;9(1):56–66.

Fan J, Zhao H, Liu Y, Kong L, Mao J, Li J. Psychometric properties of a Chinese version of the Fraboni scale of ageism: evidence from medical students sample. BMC MED EDUC. 2020;20(1):8.

Maslach C, Schaufeli WB, Leiter MP. Job burnout. ANNU REV PSYCHOL. 2001;52:397–422.

Li C, Shi K. The impact of Distributive and Procedural Equity on Job Burnout. ACTA PSYCHOL SIN 2003(05):677–84.

ÅTEG M, HEDLUND A. Researching attractive work. Analyzing a model of attractive work using theories on applicant attraction, retention and commitment . 1th edition: Linnéuniversitet: Repro Copycenter; 2010.

Liu Z, Zhang Y. A Preliminary Investigation and Analysis on the attractiveness of the Pension Service Industry to talents in China. Sci Res Aging. 2016;5(03):25–32.

Hwalek M, Straub V, Kosniewski K. Older workers: an opportunity to expand the long-term care/direct care labor force. GERONTOLOGIST. 2008;48(Spec 1):90–103.

Kim B, Liu L, Ishikawa H, Park S. Relationships between social support, job autonomy, job satisfaction, and burnout among care workers in long-term care facilities in Hawaii. EDUC GERONTOL. 2019;45(1):57–68.

Yan Z. An ethical glimpse into nursing Home Care Work in China: Mei Banfa. ETHICS SOC WELF. 2020;14(4):417–24.

Yan Z. I tried to control my emotions : Nursing Home Care Workers ' experiences of Emotional Labor in China. J CROSS-CULT GERONTO. 2022;37(1):1–22.

Chenoweth L, Jeon YH, Merlyn T, Brodaty H. A systematic review of what factors attract and retain nurses in aged and dementia care. J CLIN NURS. 2010;19(1–2):156–67.

Li CC, Yamamoto-Mitani N. Ward-level nurse turnover and related workplace factors in long-term care hospitals: a cross-sectional survey. J NURS MANAGE. 2021;29(6):1587–95.

Halter M, Boiko O, Pelone F, Beighton C, Harris R, Gale J, Gourlay S, Drennan V. The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC HEALTH SERV RES. 2017;17(1):824.

Yang L, Tang C, Zhang W, Feng M, Wei P, Guo F, Gao Z. Research on the correlation between clinicians’ working hours and medical errors. Chin Health Service Manage. 2020;37(05):349–52.

Lim J. Characteristics of Elderly Care Work That Influence Care Workers’ Turnover Intentions. HEALTHCARE-BASEL 2021, 9(3).

Colindres CV, Bryce E, Coral-Rosero P, Ramos-Soto RM, Bonilla F, Yassi A. Effect of effort-reward imbalance and burnout on infection control among Ecuadorian nurses. INT NURS REV. 2018;65(2):190–9.

Kubicek B, Korunka C, Ulferts H. Acceleration in the care of older adults: new demands as predictors of employee burnout and engagement. J ADV NURS. 2013;69(7):1525–38.

North MS, Fiske ST. An inconvenienced youth? Ageism and its potential intergenerational roots. PSYCHOL BULL. 2012;138(5):982–97.

Reyna C, Goodwin EJ, Ferrari JR. Older adult stereotypes among care providers in residential care facilities: examining the relationship between contact, eduaction, and ageism. J GERONTOL NURS. 2007;33(2):50–5.

Sao JJ, Amado CA. On studying ageism in long-term care: a systematic review of the literature. INT PSYCHOGERIATR. 2017;29(3):373–87.

Xu D, Wang Y, Li M, Zhao M, Yang Z, Wang K. Depressive symptoms and ageism among nursing home residents: the role of Social Support. INT J ENV RES PUB HE 2022, 19(19).

Lai VS, Yau SY, Lee LY, Li BS, Law SS, Huang S. Caring for Older People during and beyond the COVID-19 Pandemic: Experiences of Residential Health Care Workers. INT J ENV RES PUB HE 2022, 19(22).

Feng Z, Glinskaya E, Chen H, Gong S, Qiu Y, Xu J, Yip W. Long-term care system for older adults in China: policy landscape, challenges, and future prospects. Lancet. 2020;396(10259):1362–72.

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Acknowledgements

Thanks to Huazhong University of Science and Technology for providing the referral letter. Thanks to all the nursing home directors in Wuhan and Kaifeng for their support during the survey.

This work was supported by Humanities and social science foundation of Ministry of Education of China (grant number 20YJZAH054) and National Key Research and Development Program of China [grant number 2023YFC3806503].

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Xiaojing Qi and Ziyan Dong are co-first authors.

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Department of Nursing, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China

Xiaojing Qi

School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Ziyan Dong, Wen Xie, Liuqing Yang & Jie Li

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Qi X.J, Dong Z.Y conceived the study. Qi X.J conducted literature retrieval, screening and data collection, data analysis, and data interpretation. Dong Z.Y drafted and revised the manuscript. Dong Z.Y, Xie W, and Yang L.Q helped data collection. Li J helped revise the manuscript. All authors have read and approved the manuscript.

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Correspondence to Jie Li .

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Qi, X., Dong, Z., Xie, W. et al. Professional attractiveness among long-term care workers in nursing homes in China: a cross-sectional study. BMC Health Serv Res 24 , 548 (2024). https://doi.org/10.1186/s12913-024-11023-x

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DOI : https://doi.org/10.1186/s12913-024-11023-x

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